Chemo it is...

           You know how some people say losing weight isn’t the hardest part of a diet, that it’s keeping it off that’s the real stinker? Well, I guess in some ways the same goes for cancer. In my case, removing it wasn’t the hard part. It was caught early, stage 0 and stage 1 for the left and right breast tumors, respectively.  The tumors had several other features that were good signs, too: estrogen and progesterone positive (which means more treatment options and typically indicates a better prognosis), HER2 negative (also usually indicative of a better outcome) and they hadn’t invaded the lymph nodes. The only real surprise during surgery was that the invasive cancer was larger than originally thought at 2.1 cm (or about an inch, for the last couple of countries left in this world who don’t use the metric system).

This is an oncologist, but not mine.
I think I'd crap my pants if it were,
especially if he used the words "bloodletting."

No, for me, the hard part would be keeping it from coming back. Before I had even had time 

to really celebrate my new boobs and negative lymph nodes, I was treated to a reality check. My tumors were aggressive little fuckers, according to the oncologist (although not in those exact words). Hopefully you never have to see the inside of this specialist’s office, but if you do, be prepared. Oncologists are often sweet and kind, given the patients they have to work with, but they’re definitely not there to blow rainbows and sunshine up your butt.

I had an inkling of the tumors' aggression and even wrote about it pre-surgery in my blog “Don’t know much about pathology.” Several things sent chills down my spine as I read the biopsy reports, but two things that really bothered me—and apparently the oncologist—were “evidence of lymphovascular invasion” and the grade of the tumors, 3, which is one of the worst grades possible. The lymphovascular invasion basically meant that the cancer had breached the barriers to my blood vessels, and although my lymph nodes were negative, cancer cells could have gotten out and went their merry way elsewhere in my body via the vascular system. The grade 3 designation meant that the cancer cells looked nothing like the breast cells they started out as, they were growing rapidly and typically these tumors have a poorer outcome. Any hopes I had of avoiding chemo went quickly out the window. Luckily, my hopes had been low anyway because I’m a glass-is-not-only-half-empty-but-it’s-cracked-and-leaking-water kind of gal.

A totally non-anxiety-inducing picture of a chemo vial.

So, in case anyone out there was wondering, currently I’m considered “cancer-free,” though I’m somewhat hesitant to use those words. The chemo is an insurance policy of sorts that I don’t go through all this shit again in the near future. Additional analysis of the tumors and their asshole properties—testing called MammaPrint—showed what the oncologist predicted: I’m high risk, with an almost 30 percent risk of the cancer coming back in the next several years. That’s, uh, not cool. An additional policy for me will likely be taking a drug therapy such as tamoxifen over the course of several years to target those slow-growing cancer cells that may have escaped and are hiding out in my body. Chemo attacks the aggressive ones.

I’ll likely begin my chemo this month for either a 16- or 18-week regimen (which I end up doing depends on several factors, including my white blood cell counts). I’ll have an echocardiogram to check for any abnormalities in my heart, because chemo is considered cardio toxic and can really hurt hearts that are already ailing. Because chemo hinders the body’s natural healing process, I’ll also need to put off yanking my ovaries till my regimen is over. (I’d love to be able to do that right now because my tumors fed off of estrogen, which is produced by the ovaries.) Nipple assemblage will be in there somewhere, too.
                Lots of fun stuff to look forward to, as you can see. Hey, maybe this Christmas I’ll ask Santa for some medical marijuana! Plan B: our neighbors across the street.

               
               

Don't know much about pathology

           There are some things that are better left unopened. For example, a manila envelope containing pathology reports.
            I had set up an appointment with a prominent New York City gynecological oncologist for Nov. 6 to talk about my ovarian cyst, and I needed to bring her up to speed on that and everything in between. So I innocently swung by my breast surgeon’s office and picked up a copy of my patient chart.

This is me in Imaginary World, stocking up
on the necessities to make my family wonderful meals
soon after my double mastectomy.

Up until now, I had remarkably scant knowledge of my cancer, except for that one side appeared to be in the very earliest stage while the other one was invasive. That had been fine for me. I could pretend that everything would be rosy after surgery, that everything was neatly contained within the breast and that my cyst was a miracle that had helped me detect this invader super early. I would have my double mastectomy on November 11 and would in no time be baking cookies for my children every day and putting dinner on the table just as my husband walked in the door at night. Ha ha ha! Did I just write that? Actually, what I meant to say was, “I would have my double mastectomy on November 11 and would in no time be preventing my children from burning down the house—at least for one day—and be showered in time to get takeout with the family.”

But curiosity got the better of me and I opened that envelope. As I dug in, my fingers inched their way to the laptop and, ultimately, found themselves Googling a crash course in pathology/histology. I was accustomed to writing health stories for savvy consumer audiences, so this crap went waaaay above my level of expertise.
            “Infiltrating, high grade ductal carcinoma.” Why does the word “infiltrating” sound so much worse than “invasive,” though they mean the same thing? And “high grade?” That was typically a good thing, except in the world of oncology. The report described the mass in the right breast as one of the shittiest grades—grade 3: The breast cells looked nothing like normal breast cells, they were dividing rapidly and were poorly differentiated.

Infiltrating ductal carcinoma-- or a Formica
bathroom countertop from the '90s. Hard to tell.

According the American Cancer Society, “Poorly differentiated carcinomas lack normal features, tend to grow and spread faster, and have a worse prognosis.” Good to know. I tried to look on the bright side: Maybe I did indeed catch this aggressive cancer early and whew! Isn’t that a good thing? On the flip side, maybe my head wasn’t actually my head but a MASSIVE METASTATIC TUMOR!
            “Lymphovascular invasion is present.” Again, I defer to the American Cancer Society: “If cancer cells are seen in small blood (or lymph) vessels under the microscope…cancer is growing in these vessels and there is an increased risk that it has spread outside the breast.” Well, that would explain my head.

Another key component of the reports is hormone receptors, which my surgeon and I did discuss face to face. My masses were estrogen receptor (ER) and progesterone receptor (PR) positive, which I’ve been told is a good thing. It means that some very effective estrogen-blocking therapies would be available to me following surgery, and the overall prognosis is typically better than if these receptors tested negative. The status of another receptor, called Her2, is still undergoing testing because it came back inconclusive the first time. (You want that one to test negative, and my breast surgeon says ER- and PR-positive tumors tend to go hand-in-hand with Her2-negative. I remain cautiously optimistic.)

DCIS. You're S.O.L.

“Ductal carcinoma in situ (DCIS) of high nuclear grade with comedo necrosis and associated microcalcifications.” Say what now? According to BreastCancer.org, this means that my early stage ductal carcinoma in situ is high grade (damn it, there’s that phrase again!), and I have a higher chance of a recurrence of cancer within the first five years after diagnosis. Well, doesn’t that give me something to look forward to!
            So by now I’m totally confused. Some things gooood, other things baaad (as Frankenstein might say). Are some of these factors more important than others? Or, more likely, did they all fit together to help form a more complete picture, some of which was still missing because I hadn’t had surgery and staging yet? Now that I think about it, maybe this is best left up to the folks with the MDs after their names, who will perhaps one day include me in this conversation and stop dumbing things down. 

Maybe I should stop Googling now. Maybe not. Let’s see, “Symptoms of OCD…”